Expansive mortar-induced ocular injury

We describe here a case of bilateral chemical injury (with an expansive mortar which is being used in recent times to cut the rocks). On examination limbal ischemia was more in the left eye (9 clock hours) than the right eye (2 clock hours). The case was managed by bilateral removal of foreign bodies, along with conjunctival resection and amniotic membrane transplantation in the left eye. At six-month follow-up, patient had best corrected visual acuity of 20/30 and 20/60 in the right and left eyes respectively. Since this being an occupational hazard, proper eye protection gear should be used by persons using this expansive mortar.     

Ex-vivo potential of cadaveric and fresh limbal tissues to regenerate cultured epithelium

PURPOSE: To evaluate and compare the ex-vivo growth potential and formation of cultured corneal epithelium from residual corneo-limbal rings obtained from the operating room after penetrating keratoplasty, and fresh limbal tissues from patients undergoing routine cataract surgery. METHODS: With the approval of the Institutional Review Board and informed consent from patients, 1-2 mm of limbal tissues from 15 patients and 31 tissues from the cadaveric limbal ring preserved in MK medium (16 tissues) and Optisol (15 tissues) were used for the study. Donor data included age, time lapse between death and collection, collection and preservation and preservation and culture. Tiny bits of the limbal tissue were explanted on the de-epithelialised human amniotic membrane prepared following standard guidelines, and cultured using Human Corneal Epithelial cell medium. Radial growth from the explant was observed and measured by phase contrast microscopy over 2-4 weeks. After adequate confluent growth, whole mount preparation of the membrane was made and stained with haematoxylin and eosin. Part of the membrane was fixed in formalin and processed for routine histologic examination. The sections were stained with haematoxylin and eosin. RESULTS: Forty-six tissues were evaluated from 42 eyes (15 from patients, 31 from cadaveric eyes) with a mean age of 55.3 years +/- 21.23 years (range 18 years - 110 years). The growth pattern observed was similar in all the positive cases with clusters of cells budding from the explant over 24-72 hours, and subsequent formation of a monolayer over the next 2-3 weeks. The stained whole mount preparation showed a radial growth of cells around explants with diameter ranging from 5 to 16mm. Histologic evaluation of the membrane confirmed the growth of 2-3 cell-layered epithelium over the amniotic membrane. Cultivated epithelium around explant cell cultures was observed in 100% (15/15) of limbal tissue obtained from patients, as against 56% (9/16) of MK medium preserved tissues and 46.7% (7/15) of Optisol preserved tissues. This was statistically significant (P=0.0131) There was no significant statistical difference in the growth properties, i.e, the mean percentage of fragments showing growth (P=0.229) or the mean diameter of growth (P=0.479) in the cultures obtained from fresh and preserved tissues. The time lapse at various stages between death and utilisation and donor age had no significant influence on the growth potential of the limbal tissues. CONCLUSION: The potential for generating cultured corneal epithelium from fresh limbal tissues obtained from living subjects is higher than that observed with preserved tissues. It would also be worthwhile to address the factors that could further enhance the proliferative potential of the cadaveric tissues obtained from eye banks.     

Limbal stem cell transplantation

The past two decades have witnessed remarkable progress in limbal stem cell transplantation. In addition to harvesting stem cells from a cadaver or a live related donor, it is now possible to cultivate limbal stem cells in vitro and then transplant them onto the recipient bed. A clear understanding of the basic disease pathology and a correct assessment of the extent of stem cell deficiency are essential. A holistic approach towards management of limbal stem cell deficiency is needed. This also includes management of the underlying systemic disease, ocular adnexal pathology and dry eye. Conjunctival limbal autografts from the healthy contralateral eye are performed for unilateral cases. In bilateral cases, tissue may be harvested from a cadaver or a living related donor; prolonged immunosuppression is needed to avoid allograft rejection in such cases. This review describes the surgical techniques, postoperative treatment regimes (including immunosuppression for allografts), the complications and their management. The short and long-term outcomes of the various modalities reported in the literature are also described.     

Cataract surgery in patients with Mooren's ulcer

PURPOSE: To assess the outcome of cataract surgery in patients with Mooren's ulcer. SETTING: Ocular Immunology and Uveitis Service, L.V. Prasad Eye Institute, Hyderabad, India. METHODS: In this interventional case series, the medical records of 6 patients with Mooren's ulcer who had cataract surgery were retrospectively reviewed. Five patients had uneventful extracapsular cataract extraction with intraocular lens (IOL) implantation, and 1 patient had phacoemulsification with IOL implantation. The visual acuity and postoperative course of the patients were reviewed. The patients were followed to detect, and if present treat, a recurrence of Mooren's ulcer. RESULTS: The follow-up ranged from 3 months to 2 years. The preoperative visual acuity ranged from 20/60 to hand movements. Postoperatively, the best corrected visual acuity improved to 20/20 to counting fingers close to face. Mooren's ulcer recurred 8 months after surgery in 1 patient and was treated appropriately. CONCLUSIONS: Results indicate that cataract surgery can be safe in patients with Mooren's ulcer and visually significant cataract. Performing surgery in a quiet, noninflamed eye improves the prognosis in these cases.     

Cataract surgery in Stevens-Johnson syndrome

Cataract surgery can be safely performed in patients with Stevens-Johnson syndrome (SJS) with visually significant cataracts. Maintaining ocular surface integrity improves the prognosis of cataract surgery in this high-risk population. We present the outcome of cataract surgery in a retrospective chart review of 3 eyes in 2 patients with SJS. Uneventful extracapsular cataract extraction with intraocular lens implantation was performed. Follow-up ranged from 3 to 24 months. The visual acuity and ocular surface integrity were reviewed. The preoperative visual acuity was counting fingers at 1 meter in all 3 eyes. The best corrected visual acuity (BCVA) improved to 20/40 in 2 eyes and 20/50 in 1 eye postoperatively. A drop in BCVA ranging from 20/100 to 20/200 was noted during follow-up.     

Outcome of pterygium surgery: analysis over 14 years

AIM: To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. METHODS: Retrospective analysis of medical records of 920 patients (989 eyes) with primary and recurrent pterygia operated between January 1988 and December 2001. The demographic variables, surgical technique (bare sclera, primary closure, amniotic membrane transplantation (AMT), conjunctival autograft (CAG), conjunctival-limbal autograft (CLAG), or surgical adjuvants), recurrences and postoperative complications were analysed. RESULTS: A total of 496 (53.9%) were male and 69 (7.5%) had bilateral pterygia. Bare sclera technique was performed in 267 (27.0%) eyes, primary conjunctival closure in 32 (3.2%), AMG in 123 (12.4%), CAG in 429 (43.4%), and CLAG in 70 (7.1%). Adjuvant mitomycin C was used in 44 (4.4%) cases. The mean duration of follow-up was 8.9+/-17.0 and 5.9+/-8.8 months for unilateral primary and recurrent pterygia, respectively. The overall recurrence rate was 178 (18.0%). Following primary and recurrent unilateral pterygium excision respectively, recurrences were noted in 46 (19.4%) and 1 (33.3%) eyes after bare sclera technique, five (16.7%) and 0 after primary closure, 28 (26.7%) and 0 with AMG, 42 (12.2%) and five (31.3%) with CAG, and nine (17.3%) and two (40%) with CLAG. Recurrences were significantly more in males with primary (23.3 vs 10.7%, P<0.0001) and recurrent (26.7 vs 0%, P=0.034) pterygia, and in those below 40 years (25.2 vs 14.8%, P=0.003). CONCLUSION: CAG appears to be an effective modality for primary and recurrent pterygia. Males and patients below 40 years face greater risk of recurrence. Bare sclera technique has an unacceptably high recurrence. Prospective studies comparing CAG, CLAG, and AMG for primary and recurrent pterygia are needed.     

Recent onset neurofibromatosis complicating eclampsia with maternal death: a case report

Neurofibromatosis in pregnancy has been associated with poor perinatal outcome. A 30-year-old multigravida developed peripheral lesions of neurofibromatosis during the third month of pregnancy. She had eclampsia complicated with fatal left-sided massive intracerebral haemorrhage detected on computed tomography at 8.5 months gestation. Investigations were suggestive of HELLP syndrome. A still-born male baby was delivered. In spite of all supportive measures the patient died on the third postpartum day. We conclude that recent onset neurofibromatosis in current pregnancy should be considered as a predictor of potentially adverse maternal and fetal outcome and such pregnancies be managed in tertiary level referral centre.     

Successful perinatal outcome following recurrent idiopathic cerebrovascular strokes in pregnancy: a case report

A 25-year-old gravida 2 had two right cerebral hemispheric infarcts documented on magnetic resonance imaging (MRI) and computed tomography (CT) scan at 23 and 31 weeks of pregnancy. Investigations failed to reveal any cause. She was empirically treated with heparin, aspirin and nimodipine and had a successful perinatal outcome.